Rosa presents her research findings on satisfaction in retirement villages

Posted by Rosa Griffiths on 11 March 2024

Tags: Frailty Index, Retirement Villages

It was wonderful to have Rosa Griffiths present her research findings at our recent Friends of HOPE Event - QuizTime. There is a lot of interest in retirement living and Rosa has agreed to publish here talk here.

Rosa Griffiths tells us about her summer research project at the recent HOPE fundraiser.

Good afternoon and thank you for having me today. My name is Rosa Griffiths and I’m a third-year medical student at the University of Auckland. Thanks to the HOPE Foundation, I was lucky enough to receive a research scholarship over the summer. This took place at North Shore Hospital in the University department of geriatric medicine. My supervisors, Dr. Katherine Bloomfield and Dr. Zhenqiang Wu were a huge part of my learning experience during this project so I would love to thank both of them. I’d also like to acknowledge the other members of the research team: Annie Tatton, Cheryl Calvert, Michal Boyd, Joanna Hikaka, Dale Bramley and Prof Martin Connolly.

After being involved in this project, I have gained an appreciation for research and had a great introduction to what is involved in writing and publishing a paper, and I would love to be able to make research a part of my future in medicine. It has also been really interesting being introduced to the field of geriatrics, and understanding some of the issues that affect the health of older adults in New Zealand. I’ve found it to be a really holistic field that would be great to work in.

The project I worked on over summer was part of a larger study on older adults in retirement villages. It was a cross-sectional study, so all the data was already collected and my job was to look back on this data and draw conclusions from that. 

Specifically, we were focusing on satisfaction within retirement villages, and the question we wanted to answer was are older adults who are living with frailty satisfied with retirement villages? And how does this compare to other residents not experiencing frailty.

In short, frailty is the state of being more vulnerable to adverse health outcomes due to a decline in physical, social, or mental health. For older adults living with frailty, events that would be minor for some can lead to major changes in health.

Previous work done for the study found that there is a high prevalence of frailty in retirement villages, and the inspiration for looking at satisfaction came from learning about some of the experiences that residents living with frailty were having, both in the literature and when speaking to people in the retirement village population. It was noted that even though most studies talk about satisfaction being high, not everyone was having this experience, and we wanted to see if this was associated with frailty.

 We also wanted to use a numeric measure of frailty in the study to support our findings as this had not been done before.

The study involved recruiting residents from 33 retirement villages in the Auckland and Waitematā DHB regions, ending up with a sample of 578 residents. The participants completed a survey which included questions on satisfaction – we asked about overall satisfaction, satisfaction with social activities, opportunities to be active, security, affordability, and services offered within village. Each person filled out whether they were very satisfied, satisfied, or neutral to very dissatisfied with each of these categories. After all the individual data was collected, we developed a frailty index and used this to measure frailty in each participant.

My involvement in the study was firstly conducting a literature review. I looked for existing research surrounding frailty, and retirement village satisfaction. I found that while there were several studies on satisfaction, none of them looked at satisfaction through the lens of an objective measure of frailty. This means this is a novel study. I was also involved in analysing this data with the help of Zhenqiang, who is a statistician. We used the programme SPSS to find out if there was any relationship between this frailty index and the levels of satisfaction with the different aspects of villages. 

What we found in our initial analysis was those who were less satisfied had a higher average frailty index. We then adjusted for potential confounders and found that this association was still present, was significant and for our sample, frailty is associated with lower levels of satisfaction overall and specifically satisfaction with social activities, opportunities to be active, affordability and services offered within the village.

 Another thing we looked at was how the factors involved in relocating to a village can differ for those who are frail. What we found was older adults experiencing frailty were more likely to move into a village following a trigger event that prompted or hastened their move to a village, for example, illness or a new disability. This gave us some insight into why frail older adults move into Retirement Villages, and it is possible that moving under such conditions may lessen autonomy or sense of control for these people, which might also impact on satisfaction. It also may influence what they and their families might be expecting in village services upon moving.

Overall, we found older people with frailty are less satisfied with retirement village living across several services or aspects of village life, which we think is an important finding, particularly as the village industry sells itself on providing multiple services onsite and reports very high rates of satisfaction in general. Other research within our retirement village study has shown that there is a lot of variability in terms of the health and wellbeing of residents. Some are very fit and active, while others have greater health needs. While villages market themselves on offering a range of services, including opportunities for social and physical activities as well as security and maintenance, it is likely that residents have a range of expectations reflecting their individual life-situation.

We know there are multiple factors that influence frailty development and progression in people, not just health conditions or diseases but also many social and other factors such as loneliness and physical activity. It is concerning to see older people with frailty being less satisfied with these aspects of village life, suggesting services may not be adequate for those who are frail. We cannot draw too many conclusions directly in terms of this relationship, but it is possible that by not receiving adequate services in these areas this might be driving further frailty progression for these residents.

In writing the discussion section for this publication, I looked at the literature about other reasons why this relationship between frailty and satisfaction might exist. One thing that was interesting to read were the experiences older adults living with frailty had with the social environment of retirement villages.

I read about experiences of exclusion and stigmatisation that potentially inform some of our results. Some of the literature talked about this idea of an “us and them” mentality in retirement villages, where the more independent residents who could engage in social activities more easily had a negative perception of the residents who were less independent and needed more assistance to participate socially. These wider social influences and interactions may also impact on individual satisfaction with village-life.

If there is an opportunity for future research, it would be good to gain a more detailed perspective of the needs and expectations of those in retirement villages who experience frailty. Since our study was quantitative – it was more numbers based and couldn’t delve into the reasoning behind our results. Interviewing older people with frailty directly and exploring why they are less satisfied with services available in village or what the barriers might be in terms of these services would be helpful for coming up with future interventions with the potential to improve the wellbeing for these people.

We hope this study is informative for older adults and their families who are making decisions about their housing in the future. It would be good if those involved in the industry of retirement villages took some of this info on board to reflect and help understand how to better serve the residents who are the most vulnerable.

Publications relating to the study of Older People in Retirement Villages are listed here.